Gliederung

Objective: Soon after antibiotics were introduced to treat bacterial infections, resistance to these agents occurred. An increasing incidence of 20 percent of MRSA (number of MRSA to all Staphylococcus areus infections) was recorded in Germany in the last 10 years. The recent emergence of MRSA created a difficult problem in treating many hospital aquired infections soon after it was discovered. The frequent colonization and infection of the upper-airway-mucosa with MRSA needs a special care by doctors and nursing staff.

In this survey we are dealing with the importance, occurrence, therapy and prevention of MRSA in special consideration to head and neck surgery.

Methods: A literature review and an up to date recommendation to MRSA infection/colonisation in head and neck are presented. We evaluated routine microbiological swabs and screening examinations from patients with potential risks to MRSA from the in- and out-patients of the ENT-clinic in the years from 2002 to 2004.We evaluated also the results of MRSA infested wards of the university hospital in the same period of time.

Results: Literature: Frequent evidence of MRSA in tracheal secretion of tracheotomy patients and in acute and chronic ear diseases with prevalence of 13 percent in asian countries are described in the international specialized literature. Despite of the medical services continuous evidence of MRSA could be due to persistence in adenoids and tonsills. A colonization of MRSA on aurioscope earpieces used in isreali community pediatric clinics were found in 9 percent. In literature there are often only single case descriptions of MRSA infections for instant in dacryozystitis or jaw osteomyelitis. Practice: Doctors in clinics of head and neck surgery deal every day with mucous membrane of nose and throat and use examination instruments like specula, spatula and endoscope. They deal every day with MRSA-risk patients like patients with chronic or malignant diseases and frequent hospital residence, patients from intensive care units, with tracheostomy and patients from nursing homes and rehabilitation clinics. Family doctors and ENT-doctors are often criticized for frequent and uncritical prescription of antibiotics in upper airway infections because of favouring the development of antibiotic resistance. Own results: We found an increasing number of patients with MRSA at the university hospital of rostock from 2002 to 2004. Also an increasing number of normal wards but especially of intensive care units were infested with MRSA. The increasing number of MRSA affects the nosocomial as well as not-nosocomial infections and colonizations. In comparison with other hospitals in germany there are only a small number of MRSA-patients at the university of rostock. The molecular subtype wich occured most frequently is the Rhein-Hessen-Typus.At the ENT-clinic of the university of rostock we found only a small but an increasing number of MRSA-patients. Nearly all MRSA-patients belong to the MRSA-risk persons and often the MRSA-colonization was already known. The affected localizations of positive MRSA-swabs are: tracheostoma (n=5), nose(n=5), throat (n=2), ear, forehead, parotis, cervical wound infection, decubitus and urin (each n=1). In 4 patients an unknown colonisation of MRSA could be proofed but 3 of them were high-risk patients for MRSA.

Conclusions: A further spreading of MRSA is expecting due to an increasing number of patients with intensive care therapy and following rehabilitation. Besides medical aspects the financial charge of MRSA to the health system is of enormous importance. There is an urgent necessity for a consistant MRSA-management:screening of patient with risk for colonization of MRSA; consistant observance of hospital sanitary; documentation, communication and information of follow up facilities; correctly use of antibiotic prescriptions.

In the past years, many studies showed the efficacy of such precautions.